Unprecedented population growth in developing countries will increase pressure on the environment and on the earth's carrying capacity. The current phenomenal growth in urbanization in developing countries has exacerbated efforts to secure environmental health. In India, the urban population is growing at a faster rate than the rural population, with about half of urban dwellers living in slums. Therefore, efforts to improve conditions in slums have been the subject of a number of recent projects. Challenges include providing sufficient housing in urban areas and improving ventilation, illumination, and exhaust of cooking fuels in rural houses. The water supply is threatened both in quality and quantity, and 89.2% of households in India lack or fail to use latrines. Lack of proper management of solid wastes and lack of drainage has led to serious health risks, and the safety of the supply of edible food sold in shops and schools is far from satisfactory. A lack of proper hygiene associated with infant feeding contributes significantly to infant mortality. School children exhibit a lack of personal hygiene, and often play in dirt and muddy water. Other problems are associated with the environmental ill-effects of home-based industries, pollution of the air and rivers, and behavioral-related health problems such as alcoholism, drug addiction, and high-risk sex behavior. Many innovative approaches exist as models for the development of the information, education, and communication programs necessary to improve the environment.
Globally, there have been improvements in the world's health, but in many countries the infant mortality rate is rising. Widespread disease is present in many developing countries. 250 million people suffer from filariasis and 30 million more have onchocerciasis or river blindness. 200 million are infected with schistosomiasis and each year 150 million new cases of malaria are registered. Over 5 million children die from diarrheal diseases in developing countries. Many health experts now believe that there is a way to rectify this situation by transforming the medical technostructure. The challenge for the "Health for All" movement is to find a health service that people can afford and in which people can play a major role. Community participation is an important part of this movement. Lower costs for health care, better distribution of funds for health, and more equitable distribution of resources are necessary. The concept of "Health for All" challenges the prevailing concept of development in which human communities are considered passive.
Throughout the world, the concept that the best milk is breast milk is gaining momentum from ever increasing supportive scientific evidence. In India the average mother even with her poor nutritional status has the ability to breastfeed her infant for prolonged periods, sometimes extending to nearly 2 years. Human milk generally forms the only source of dietary protein for poor Indian infants, and the nutritional status of poor infants and children would be much worse than what it is today if not for breast milk. The positive economic and health implications of breast milk are obvious; it is the most hygienic, safest, and suitable nourishment a mother can provide for her infant. Recently, there has been an unfortunate trend toward artificial feeding among the average Indian mother. This practice is spreading among rural mothers and mothers of low socioeconomic groups. Due to poverty and ignorance many mothers neither can prepare the artificial milk feeding formula hygienically nor feed their children well, and the children are not only deprived of essential nutrients but are exposed to unnecessary intestinal infections introduced through unsterilized bottles and nipples. The Protein Advisory Group of the UN has warned against early abandonment of breastfeeding, particularly in poor families, as devastating to the health and survival of infants. The practice of artificial feeding also has adverse economic implications. The expenditure incurred in the processing, packing, distributing, preparing, and refrigerating cow's milk is enormous and one that a developing country like India cannot afford. Breast feeding also has the advantage of a certain amount of contraceptive effect. Generalizations for the promotion of breastfeeding include the following: 1) unsupplemented human milk is all that is needed to sustain growth and good nutrition for the first 6 months of life; 2) the volume and composition of human milk among poor women is surprisingly good despite their low nutrition status; and 3) limited studies have suggested that improvement in both the quantity and quality of breast milk is feasible. Modifications that should be made in health services are outlined.
Sri Lanka's population activities at the national level are undertaken through 12 multidisciplinary programs involving several UN agencies and 7 national ministries. The projects cover major areas of the program and are funded by the United Nations Fund for Population Activities (UNFPA). They do not function in isolation and are components of the family health program. Sri Lanka possesses an impressive infrastructure for population information and education and the main channels utilized are the mass media and interpersonal communication. A large army of field workers help in the effort to bring the message into the homes of the people. Population communication programs in Sri Lanka have demonstrated their effectiveness in disseminating, on a broad basis, factual information on population and family planning services and facilities. Communication activities also help to speed up the process of change, to reinforce knowledge, and to ensure a continuous educational system for the community in general and specific technical and basic information for target audiences in order to increase efficiency. Thus, population communication functions at 2 levels: that of providing basic information for purposes of motivation; and assisting in the decision making process. The mass media are used for the 1st purpose, and interpersonal efforts play a dominant role in the 2nd. Both these efforts, which are reviewed, are supported by other means of communication such as audiovisual aids, while multimedia efforts have been found useful in sustaining levels of interest in the program.
